Healthcare Provider Details

I. General information

NPI: 1114789948
Provider Name (Legal Business Name): HANNAH G. O. MCMANNES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH G. OSCARSON PA-C

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 OLD CEDAR AVE S
BLOOMINGTON MN
55425-1207
US

IV. Provider business mailing address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

V. Phone/Fax

Practice location:
  • Phone: 952-428-1800
  • Fax:
Mailing address:
  • Phone: 952-428-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3030
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15754
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number124166
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: